Shortage Of Dermatologists Research Articles

Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study.

The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care. To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months). Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period. In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care. Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.

Building successful culture, mission, and vision in dermatology.

Building a successful culture in academic dermatology is necessary now more than ever, which is compounded by the shortage of dermatologists, especially academicians. This dearth of academic dermatologists raises questions concerning who will train future generations of physicians and who will drive innovative research to advance the field and improve patient care. Recruitment and retention of dermatologists in academia faces steep challenges posed by increasing demands within academic medicine and the draw of the private sector. It is important to address barriers to a career in academia. Efforts should be focused on modifiable aspects of dermatology residency experiences to promote a career in academic dermatology. Of equal importance is the retention of faculty already in academia because midcareer shifts from academic settings to private practice can result in a significant leadership gap.

35159 The dermatology education series: A digital approach to improving patient engagement

Dermatology is unique in that not only are there a shortage of dermatologists in the United States but patient access care to is largely disproportionate. As a response to the chasm of access that exists, many patients have relied on the Internet to obtain information on how to address their concerns, and this often comes at the cost of non-evidence based remedies being promoted. The inception of the 2020 COVID-19 pandemic has led many physicians to restrategize their approach to patient care. Fortunately, utilization of a virtual model has been integral to this process.

Direct-to-Consumer Teledermatology Growth: A Review and Outlook for the Future

The direct-to-consumer (DTC) telemedicine industry, including teledermatology, has seen rapid expansion in recent years, partly because of the COVID-19 pandemic. The shortage of dermatologists and the visual nature of dermatologic conditions attracted DTC companies to dermatology. As more patients continue to seek medical consultations and prescription medications from these for-profit companies, we must approach their growth with healthy skepticism. Shortcomings of DTC teledermatology include concerns about conflicts of interest (COIs), overdiagnosis, and overprescribing. Although DTC teledermatology is certainly here to stay, an appropriate understanding of this industry will allow dermatologists to advise patients and advocate for best practices.

Addressing geographic disparities in dermatology through virtual educational outreach

Purpose: Rural areas face significant shortage of dermatologists. Rural origin is a strong indicator of eventual rural practice for physicians, however students of rural background account for less than 5% of all incoming medical students. Increasing representation of students with rural backgrounds is important to increase the supply of dermatologists in rural areas, which have higher skin cancer mortality rates compared to urban populations. We created a virtual educational outreach program for high school students in Maine, a predominately rural state, to create interest amongst high school students in pursuing a career in health care.
 Methods: We developed a virtual pipeline program called the Inside Medicine Program that provides monthly educational workshops to high school students in Maine. For one of the sessions, we conducted a dermatology workshop teaching various topics in Dermatology. Pre- and post-curriculum surveys were sent to 33 students, which used a 10-point Likert scale to rate interest and perceived knowledge levels in these topics.
 Results: After the workshop, 100% of respondents endorsed a greater understanding of the path to a dermatology career and 94.12% stated that they were interested in learning more about dermatology. Moreover, students endorsed greater interest in pursuing a career in dermatology and reported a significant increase in knowledge about various dermatologic topics.
 Conclusions: Our results suggest that our program has improved these students’ interest and perceived knowledge in dermatology. We hope that this will promote their subsequent entry into the medical field to address shortages in subspecialty care in rural areas.

Task shifting in dermatology: Are nurses prepared and willing?

Background: The high burden of skin diseases and the shortage of dermatologists are significant challenges in providing care to millions of people with skin diseases. Task shifting to nurses is a viable option for the delivery of dermatologic care in resource-poor settings. Satisfactory knowledge and a positive attitude are crucial for nurses to undertake the task of managing common skin diseases. This study aimed to investigate the knowledge of registered nurses and their attitude toward common skin conditions. Methods: In this descriptive, cross-sectional study, a total of 187 nurses were included from a nurses training institute by total enumeration sampling. A knowledge questionnaire and five-point Likert type-attitude scale were developed, validated, and employed to collect data. Written informed consent was obtained from the participants after approval from the institute ethics committee. Results: The mean of the knowledge scores were 10.7 ± 2.2. Nearly two thirds (62%) of the subjects demonstrated a low level of knowledge, while the remaining 38% showed a moderate level. There was no participant in the high-knowledge category. A majority of the nurses demonstrated a favorable attitude toward learning and undertaking the task of managing common skin conditions. Conclusion: We observed a low level of knowledge on diagnosing and managing common skin conditions. We recommend incorporating the relevant concepts of common skin conditions in the nursing curriculum with an emphasis on continuing education.

Use of Teledermatology to Improve Dermatological Access in Rural Areas.

Introduction: Dermatological access in rural regions has been impacted due to an acute, global dermatologist shortage coupled with a striking disparity in dermatologist density between urban and rural areas. As a result, the dermatological arena has been under notable pressure to amplify access. Teledermatology has entailed the use of technology to provide dermatological services to individuals located at a remote distance. The purpose of this literature review was to examine the effect of utilization of teledermatology to determine enhancement of dermatological access to residents of rural areas. Materials and Methods: This review followed a systematic approach and utilized five electronic databases to obtain peer-reviewed journal articles. A PRISMA approach was used and a total of 86 references were employed. Results: Teledermatology programs have been able to complement conventional dermatological care to enhance dermatological access to rural areas that have suffered from a shortage of dermatologists and could aid in supplementing traditional care as well. Within rural settings, the results of three studies in this review indicated the importance of improved quality for diagnostic precision, whereas one study reported that clinical images might not provide sufficient insight to deliver clear-cut diagnoses. In addition, enhancements in diagnostic precision could be obtained by upgrades in phone cameras to capture images. Finally, to most of the existing literature, in using teledermatology, physician satisfaction has been stronger than patient satisfaction. Conclusions: Teledermatology has had a beneficial impact in improving dermatological access to rural areas. The success of this technology is contingent upon the commitment and willingness of the dermatologist in utilizing it.

Paving the Way for Future Medical Dermatology Leaders in Psoriasis and Psoriatic Arthritis: 1st Annual Mentoring Program for Dermatology Fellows

There is a growing shortage of dermatologists in the United States, with fewer dermatologists concentrating on the management of chronic diseases such as psoriasis and psoriatic arthritis. There are no programs focused on fellows interested in medical dermatology. To address this need, a mentoring conference was developed for dermatology fellows. They were nominated for the program by their advisors, and selected based on their academic potential, research interests, and experience. The conference was highly interactive with a focus on building relationships with like-minded individuals interested in academic medicine. Faculty presented the most recent, clinically relevant knowledge regarding classification, diagnosis, and treatment of psoriatic diseases. Other topics included developing research questionnaires, solidifying a hypothesis, and optimizing interactions with a mentor. Fellows presented original research and were given the opportunity to respond to critiques. The conference was considered by all to be highly successful. Plans to strengthen and expand the program for next year are under way.

Diagnosing Skin Lesions: Clinical Considerations for Primary Care Practitioners

The prevalence of skin cancer, coupled with the increasing demand that has been placed upon primary care with a shortage of dermatologists, has heightened the importance of practitioners' dermatological knowledge and skills. The need is evident for performing skin examinations for early detection of cancer, knowledge of appropriate dermatological procedures and referrals, sufficient communication with pathologists, and dermatology-related continuing education. Increased proficiency in diagnosing skin lesions by the primary care workforce will promote more timely access to quality dermatological care for patients. This article reviews important clinical considerations in the diagnosis of skin lesions.

Quoi de neuf en thérapeutique dermatologique ?

Although the isolated clinical cases published are sometimes helpful in individual situations in which the therapeutic options have been exhausted, this type of publication cannot be generalized. For this reason, the selection presented covering the period from November 2009 to October 2010 is to a very large extent based on controlled trials, either because they contribute important information or because they raise great hope for a significant number of patients. For the first time in cutaneous oncology, a treatment (ipilimumab) has significantly increased overall survival in patients with metastatic melanoma (phase III), although this gain remains modest (4-6 months) and adverse immunological effects are frequent (30-40%). A phase I trial with treatment specifically targeting the mutant BRAF protein has shown an objective response in 81% of the patients treated in the metastatic phase of melanoma, thus allowing its development to be pursued. Grouping two studies in a rare tumor such as dermatofibrosarcoma also gives hope with imatinib as a neoadjuvant treatment when the initial tumor is inoperable, with, however, an inconsistent response of approximately 50% and only if the tumor presents reorganization of chromosomes 17 and 22. Cutaneous inflammatory diseases are still dominated by dual therapies in psoriasis, with, notably, an effectiveness trial on etanercept at different doses not showing a difference in efficacy depending on dose for the joint component of psoriasis, but also by the publication of a direct comparison of two dual therapies, ustekinumab versus etanercept. In atopic dermatitis, a controversial article invites one to reflect upon the progress made in the management of children by clinical nurses, as in the Netherlands and in Great Britain, in an attempt to contend with the shortage of dermatologists. Since the use of biotherapies is not the prerogative of psoriasis, infliximab was assessed in a phase II trial in Verneuil disease without demonstrating significant efficacy on the main criterion, but it did show a tendency to reduce the score used. This trial suffered from a weakness both in methodology and statistical power, thus precluding any conclusion. The rarity of therapeutic trials on drug eruptions warrants their mention. A French phase II study gives a glimpse of a trend toward efficacy in terms of survival in the treatment of toxic epidermal necrolysis with cyclosporine. As for infectious dermatosis and sexually transmitted infections, a French multicenter study has shown significantly higher efficacy with ivermectin than with malathion in treating pediculosis without increasing the side effects. Today, however, this systemic treatment cannot be a first-line treatment outside of certain specific situations. A large cohort study (somewhat unsatisfactory in its methodology) has not demonstrated the teratogenicity of antiherpes treatments in 830,000 infants. In prevention of HIV transmission, no microbicidal gel had shown efficacy to date. This has now been accomplished in South Africa with a 1% tenofovir gel. The results of a preliminary trial on therapeutic vaccination against HPV16 proposed to women who are carriers of cervical intraepithelial neoplasia opens the way for wide vaccine therapy of cutaneous virus-induced neoplasia. In conclusion, several articles analyzing the dermatology literature provide an opportunity to reflect on the quality of such articles, Boutron's being absolutely in-dis-pen-sa-ble!

Usefulness and economic evaluation of ADSL‐based live interactive teledermatology in areas with shortage of dermatologists

To overcome the problem of maldistribution of dermatologists in rural areas, live interactive teleconsultation systems are being used in some countries. However, these systems are not in common use because few evaluations on their efficiency and economic viability were reported. We constructed an easy-to-use asymmetric digital subscriber line (ADSL)-based live interactive teleconsultation system and conducted 150 trial sessions between two rural hospitals and Shimane University Hospital. The clinical usefulness and economic advantages of this system were evaluated using data obtained from the trials. The system efficiently captured images at a resolution sufficient for specialized consultations: follicular openings were visible in the images obtained from a distance of 2 m. This system is more advantageous than a conventional clinic if the following condition is fulfilled: y ≤ 6.00 x-3.86 [x, time required for one-way travel (h); y, time required for consultation (h)]. Our two lines in trial fulfilled this condition. Asymmetric digital subscriber line-based live interactive teleconsultation technology is beneficial in many rural hospitals that do not have a dermatologist.

Canaries in the Mineshaft: The Dermatology Workforce Shortage in Eastern Ontario

The number of dermatology residency positions in Canada has not reflected the growing workforce shortage. Until 2005, all dermatology residents at the University of Ottawa were committed to return to their funding area at the completion of their training. This has left Eastern Ontario with a critical shortage of dermatologists. To survey dermatologists practicing in Eastern Ontario to understand the basis of the workforce shortage and outlook for the future. Mailed surveys sent in 1999, 2003, and 2006 to all dermatologists in Eastern Ontario requesting demographic information, workload data, and future career plans. There was a 100% response rate in each survey year. Between 1999 and 2006, the total number of practicing dermatologists decreased from 26 to 23, whereas the average age increased from 51.4 to 57.4 years. The waiting time to see new and returning patients increased, from 5.8 to 18.5 weeks and 4.9 to 11.8 weeks, respectively. Ten of the 23 dermatologists practicing in 2006 plan to retire within the next 5 years. The inadequate supply of dermatologists in Eastern Ontario will increasingly threaten patient care. This emphasizes the need for additional funding for dermatology training positions, continued mentorship, and improved dermatology training for nondermatologists.